AMIA Urges ONC to Support New Testing Infrastructure for HIT Standards

The American Medical Informatics Association (AMIA), in comments submitted to the Office of the National Coordinator for Health Information Technology (ONC), is urging the government to support a more robust, modern testing infrastructure for health IT standards.

In the comments, AMIA also called on the federal government to update and enhance the Nationwide Interoperability Roadmap. These comments were offered in response to a September call from ONC, which sought comments on its Interoperability Standards Advisory (ISA) in preparation for publication of the 2018 Reference Edition. AMIA recently developed Policy Principles and Positions related to Health IT Data Standards & Interoperability, and used these to assess the larger landscape of health IT standards as represented by the ISA.

Using its Health IT Data Standards & Interoperability Principles and Positions to assess the ISA, AMIA did not critique individual standards or sections of the standards catalogue. Rather, AMIA developed recommendations that are “important to ensure that any standards referenced in the ISA will be used consistently and prudently towards the goal of interoperability.”

Specifically, AMIA called on ONC to establish a dedicated roadmap for standards, including development of a framework for how multiple standards should fit together to support interoperability for important, national uses cases, and the broader health IT ecosystem, which will include research and consumer products. The organization pointed towards the Nationwide Interoperability Roadmap as a starting point to enhance the national health IT strategy.

"AMIA appreciates the efforts made by ONC to have an open conversation regarding the current state of biomedical data standards,” the group said in comments. “In particular, the annual ISA process has given stakeholders a chance to discuss and debate the current state of standards for specific use cases. While recent enhancements to the content and presentation of the ISA have improved the capacity for stakeholder debate, there remains a need for unbiased, strategic leadership on the current status and future direction of health IT standards. We believe this leadership is best derived from private sector experience, with public investment and convening.”

Douglas B. Fridsma, M.D., Ph.D., AMIA President and CEO, added, “Innovation depends on interoperability, and interoperability depends on the use of quality standards. To make the ISA impactful we need an overarching framework, similar to the Internet Protocol stack. Once established, this standards framework will enable the private sector to innovate in all directions.”

Another aspect of the current health IT standards landscape involves whether and how standards are tested, AMIA said in its comments. “Thorough testing remains an unrealized aspect of our nationwide approach to standards,” the group said in comments. “Very few standards undergo rigorous testing at the development-level or at the implementation-level. Both are critical if interoperability is to occur.”

AMIA also noted that ONC’s Certification Program has relied on conformance testing—testing whether systems use a specific standard—not true interoperability testing, which would test both the sending and the receiving of information. “In our experience,” AMIA said, “this is a daunting problem that warrants prompt attention from ONC and standards development organizations.”

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